Analgesics Flashcards
NSAIDS MOA
inhibit formation of various prostaglandins & decrease pain impulses received by the CNS
COX-1 physiologic effects
gastroprotective prostaglandings, thromboxane A2, vasodilation of renal blood vessels
COX-2 physiologic effects
pain, inflammation, antithrombosis, vasodilation of renal blood vessels
non-selective NSAIDS MOA and examples
inhibit cox-1 and cox-2
diclofenac
ibuprofen
ketorolac
naproxen
partially selective NSAIDS MOA and examples
inhibit cox-2 only (but inhibit both at higher levels)
celecoxib
meloxicam
AE of NSAIDs
gastric irritation, renal dysfunction, platelet inhibition, increased risk of CV events, fluid retention, may alter effects of aspirin
acetaminophen MOA
inhibits COX-1 an COX-2 in CNS (not periphery) & decreases pain impulses received by the CNS
tool used to estimate hepatotoxicity toxicity from acute acetaminophen OD?
rumack-matthew nomogram
when should long-acting/ER opioids be used?
pain requiring around-the clock long term treatment
not as needed
schedule I meds
high abuse potential
ecstasyy, heroin, LSD
schedule II meds
high abuse potential
codeine, fentanyl, hydrocodone, hydromorphone, methadone, meperidine, morphine, oxycodone
schedule III meds
moderate abuse potential
acetaminophen with codeine, ketamine
schedule IV meds
low abuse potential
tramodol
immediate-release oral opioid use & examples
moderate to severe pain
morphine
oxycodone
tramadol
IV opioids that should be avoided w renal dysfunction
meperidine
morphine
methadone MOA
pain receptor agonist, NDMA receptor antagonist, and 5HT and NE reuptake inhibitor
precautions for methadone
numerous drug interactions
monitor QTC
do not titrate > q 5 days
common AEs of opioids
autonomic - xerostomia, urinary retention, postural hypotension
CNS - resp depression, confusion, hallucinations, decreased cough reflex
cutaneous - pruritis, sweating, flushing
GI - N/V/C, ileus, obstruction
recommended meds for opioid-induced constipation
scheduled senna or bisacodyl
polyethylene glycol, MOM
available naloxone routes
IV, IM, SQ, IN, NEB, IO, ET
s/s of opioid withdrawal
N/D, coughing, lacrimation, yawning, sneezing, rhinorrhea, sweating, muscle twitching, piloerection, hot/cold flashes, muscle cramps
long term AE of opioids
addiction, physical dependence, tolerance, pseudoaddiction
adjuvant pain therapies
muscle relaxants systemic lidocaine ketamine dexmedetomidine anticonvulsants TCAs SNRIs topical agents
common muscle relaxants
baclofen - antispasmotic
cyclobenzaprine
methocarbamol
tizanidine
lidocaine MOA
Na channel blocker used as adjuvant pain therapy
ketamine MOA and use
NMDA receptor antagonist
pain adjuvant therapy helps lower opioid consumption by 40%
AE of ketamine
psychomimetic effects
HTN, tachycardia
does not cause resp depression at normal pain dosages :)
dexmedetomidine
A2-adrenergic agonist
anticonvulsants used as adjuvant pain therapy
gabapentin, pregabalin
TCAs used as adjuvant pain therapy
nortriptyline
amitriptyline
SNRIs used as adjuvant pain therapy
duloxetine
venlafaxine
therapy for nociceptive pain
1 - NSAID
2 - duloxetine or TCA
3 - opioid
therapy for neuropathic pain
1 - gabapentin, pregabalin, SNRI or TCA + topical lidocaine
2 - tramodol or combo first line therapies
3 - pain specialist referral
therapy for cancer pain
nociceptive - non-opiods + opioids/adjuvants
neuropathic - opioids + gabapentin, pregabalin, SNRI or TCA
therapy for bone pain
NSAIDS + opioids
adjuvants
